Will physicians ‘fire’ patients to meet quality measures?

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Will physicians ‘fire’ patients to meet quality measures?

AHRQ council offers ways to mitigate conflict between patient choice, metrics

November 07, 2011

Experts at an Agency for Healthcare Research and Quality (AHRQ) forum last week discussed whether physicians will “fire” noncompliant patients to ensure they meet quality metrics, CQ HealthBeat reports.

According to participants at AHRQ’s National Advisory Council forum, as more payers are instituting pay-for-performance programs, patients are becoming increasingly engaged in medical decision making and at times challenging official recommendations.

“I think we’re heading towards an inevitable clash,” says Lisa Latts, a member of the AHRQ council and WellPoint‘s vice president for programs in clinical excellence. For example, parents who refuse to follow the recommended vaccine schedule could force physicians out of compliance with immunization benchmarks and impact payments.

As a result, physicians ultimately may “fire” noncompliant patients from their practices, push back against quality-improvement initiatives, and minimize patient empowerment efforts, CQ HealthBeat reports. Some physicians already are “firing” unvaccinated patients, noting that they pose a risk to others and reflect a lack of trust for physicians’ medical advice.

To mitigate the conflict, council members suggested altering performance metrics to account for medical advice recommended by the physician but declined by the patient. Some council members also suggested adjusting down performance measures that aim for 100% compliance (Bristol, CQ HealthBeat, 11/4 [subscription required]).

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